Long-term growth in children with posterior urethral valves

Summary Background Posterior urethral valves (PUV) are one of the leading causes of pediatric chronic kidney disease (CKD). Growth impairment is prevalent in pediatric CKD and children with PUV are at high risk for growth retardation. Objective To describe growth profiles in PUV and to identify risk factors for stunting, defined as age-specific height standard deviation score (SDS) below -2. Patients and methods Medical records of 65 patients with PUV and a minimum follow-up of two years were retrospectively reviewed. CKD stage 1–3 was considered mild CKD whereas CKD stage 4–5 was considered advanced CKD. Age-specific height, weight and body mass index (BMI) SDS were determined. Seven potential risk factors for stunting, namely timing of diagnosis, renal dysplasia, timing of surgery, requirement of urinary diversion, nadir serum creatinine after surgery, recurrent febrile urinary tract infection (UTI) and severity of CKD, were analyzed. Results Median age at diagnosis, at surgery and at last follow-up was 0.51, 0.75 and 7.53 years, respectively. All patients underwent valve ablation and 33.8% required urinary diversion. Median nadir serum creatinine after surgery was 0.40 mg/dL and was higher in patients undergone urinary diversion (p recurrent febrile UTI were not associated with stunting. Median SDS of weight and BMI was -0.64 and -0.19, respectively. Patients with thinness, normal weight, overweight and obese were 26.2%, 58.5%, 10.8% and 4.6%, respectively. There was no significant difference of SDS of weight and BMI across CKD stages (Fig. 1). Discussion Deterioration in height began early in the course of disease and was worsening in relation to the decline of renal function. The impact of timing of diagnosis or surgery on height was controversial. Patients undergone urinary diversion had high nadir creatinine and were likely to have severe PUV. Although patients with severe baseline renal dysfunction may require urinary diversion, nadir serum creatinine and urinary diversion are not associated with stunting. Delaying progression of CKD could maximize linear growth potential in PUV. A substantial proportion of patients were overweight or obese. Sufficient caloric intakes may be maintained in PUV patients.